• Annals of surgery · Dec 2022

    A Pretreatment Prognostic Score to Stratify Survival in Pancreatic Cancer.

    • Thomas Hank, Ulf Hinz, Thomas Reiner, Giuseppe Malleo, Anna-Katharina König, Laura Maggino, Giovanni Marchegiani, Jörg Kaiser, Salvatore Paiella, Alessandra Binco, Roberto Salvia, Thilo Hackert, Claudio Bassi, Markus W Büchler, and Oliver Strobel.
    • Department of General, Visceral and Transplantation Surgery, Heidelberg, University Hospital, Heidelberg, Germany.
    • Ann. Surg. 2022 Dec 1; 276 (6): e914e922e914-e922.

    ObjectiveThe aim of this study was to develop and validate a pretreatment prognostic score in pancreatic cancer (PDAC).BackgroundPretreatment prognostication in PDAC is important for treatment decisions but remains challenging. Available prognostic tools are derived from selected cohorts of patients who underwent resection, excluding up to 20% of patients with exploration only, and do not adequately reflect the pretreatment scenario.MethodsPatients undergoing surgery for PDAC in Heidelberg from July 2006 to June 2014 were identified from a prospective database. Pretreatment parameters were extracted from the database and the laboratory information system. Parameters independently associated with overall survival by uni- and multivariable analyses were used to build a prognostic score. A contemporary cohort from Verona was used for external validation.ResultsIn 1197 patients, multiple pretreatment parameters were associated with overall survival by univariable analyses. American Society of Anesthesiology classification, carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen, C-reactive protein, albumin, and platelet count were independently associated with survival and were used to create the Heidelberg Prognostic Pancreatic Cancer (HELPP)-score. The HELPP-score was closely associated with overall survival (median survival between 31.3 and 4.8 months; 5-year survival rates between 35% and 0%) and was able to stratify survival in subgroups with or without resection as well as in CA19-9 nonsecretors. In the resected subgroup the HELPP-score stratified survival independently of pathological prognostic factors. The HELPP-score was externally validated and was superior to CA19-9 in both the development and validation cohorts.ConclusionThe HELPP-score is a readily available prognostic tool based on pretreatment routine parameters to stratify survival in PDAC independently of resection status and pathological tumor stage.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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